Beth Israel Hospital. (Violette79/Flickr)

The sign at the entrance to Beth Israel Medical Center on First Avenue at 16th Street screams “EMERGENCY ROOM,” but five hours into her wait to be seen for sharp pain in her ribs, it didn’t feel that way to Yamira Velazquez.

Her regular hospital, Bellevue Hospital Center, shut down after Hurricane Sandy ripped through the northeast. So did both NYU Langone Medical Center and the VA Medical Center next door. Bellevue won’t reopen its emergency room until at least February. NYU and the VA have not yet announced dates.

And so, like thousands of others seeking immediate medical care, she ended up in the emergency room at Beth Israel, the last standing hospital for two and a half miles in any direction.

“I was in pain. It was the worst,” she said.

That was on the Saturday before Thanksgiving. Each day brings its own struggles. For patients in the waiting room, Cyber Monday here felt more like a doorbuster event where the prize was a moment of medical attention.

"Oh come on... F**k," said a woman who'd been waited an hour for a nurse to see her mother as a woman cut ahead.

Another man who had been wheezing in the waiting room and said to a nurse, "Ma'am, I can't breathe," to which the nurse replied, "Well you're talking very well."

Ill patients are lucky to find an open seat while they wait for an emergency room doctor, and once there slump over through the long hours. Others hold back vomit—or let it go into pink buckets. Some moan in pain and others scream in a drunken or deranged state at other patients or their imaginations. Before it closed, psychiatric patients and arrested criminals went to Bellevue. Now, they’re showing up at Beth Israel.

“The waiting area is a little unsecure,” said Melody Rivera, after spending the better part of her afternoon in the waiting room with her sick co-worker. “People were screaming like they’re drunk and belligerent.”

Before the storm, the 871-bed hospital would average about 320 emergency room visits a day. Now, that number is well above 400, and peaked at 470 at one point in the middle of November, according to hospital officials.

The math is unforgiving: people get sick, and they now have nowhere else to go, a problem exacerbated by the shutdown of St. Vincent’s hospital in the West Village. Last year, emergency rooms at the city’s Bellevue Hospital Center and the private NYU Langone Medical Center saw nearly 150,000 patients combined, according to state Department of Health data. And the lion’s share are now being cared for by Beth Israel.

Double the usual number of ambulances churn down 16th Street into the emergency drop-off zone, peaking once in mid-November at 170 deliveries in a day and  ringing a steady chorus of sirens at the edge of Stuyvesant Town.

The backup is part of a chain reaction. Nursing homes, rehab centers and other continuing care facilities where Beth Israel normally sends patients who are well enough to leave but need further care are packed and outpatient services at the nearby hospitals are just starting to open back up. So in the meantime, they stay in the hospital wards. And then the emergency room can’t always find enough beds as new patients come in.

Colette Russen, 42, has been a nurse for the past eight years, and she’s still never seen anything like what has been happening at Beth Israel. With each nurse assigned to at least eight non-critical patients or six high-acuity ones, the little things can fall through the cracks and lead to larger problems, she said.

For instance, she was assigned one man with chest pains, and since he was stable she left to care for other patients. While she was tending to the five others she was responsible for, his symptoms started to flare up.

“He had chest pains and his daughter told me that he didn’t look so good,” said Ms. Russen. “They had to take him for intervention immediately because he had another episode. Thank God his family member was by his side. What if he hadn’t said anything and I didn’t know he had gotten pale and sweaty and quiet?”

“That’s a nurse’s worst nightmare,” she said.

Beth Israel acknowledges the backups and says it’s doing all it can to move patients through and unclog its emergency room.

“With the surge in patients that Beth Israel saw during the storm and in the days and weeks afterwards, we were attempting to safely discharge an unusually high number of patients in an abbreviated time period to try and open up some beds for patients in the ER,” said vice-president of communications Jim Mandler via email.

“There is a process that goes with safe discharge planning. It is not only about finding a bed. It’s about finding an appropriate bed. We had to make sure that home health services would be available for these patients.”

Meanwhile, to make more space in the emergency department—which doubled in 2010 to about 80 beds in response to the shuttering of nearby hospital and long term care facilities—private rooms have been converted into triage and waiting rooms for less acute patients. Staff have converted beds in specialty areas, like short stay detox, to accommodate the influx of more typical patients.

Nursing hours have been extended by 200 per day, said emergency room administrator John Samuels, while physician hours have been increased by a total of 66 hours a day.

“This used to be a private room, but we’ve turned it into a kind of triage and waiting area,” he said, pointing out a dimly lit room with five people waiting for further care. One read a newspaper, another stared blankly at the salmon-colored wall.

He said nursing staff had been bolstered by an additional eight, with two more undergoing training and orientation. The hospital has also put out feelers to find more.

They may be needed. A mountain of research has found that increasing the number of patients that a nurse has to care for leads to worse outcomes. One widely accepted study found that the for every extra patient a nurse is assigned, the risk of 30 day mortality after surgery increases by 7 percent. The national average is about one nurse to five patients, according to University of Pennsylvania professor of nursing and director of the school’s center for health outcomes and policy research, Linda Aiken. And some departments at Beth Israel hospital are now at the one to eight range.

“Those would be on the high side,” said Ms. Aiken. Departments like general medicine and surgery maintained their pre-storm ratios, but those were already above the national averages. “So for a hospital that already has staffing on the high side to absorb a lot of additional patients over a long time, on the basis of research, would be concerning.”

The biggest concern of all for the doctors and nurses is the newly arrived flu season. So far, it has been relatively light in New York City. Emergency department visits for flu like symptoms only account for 1.3 percent of total visits in the city, about half the regional and national baselines and nowhere near the 8 percent level reached during the 2009-2010 pandemic. But if that number were to spike, “that would be scary,” warns Nurse Russen.

“A flu epidemic,” said New York Presbyterian President Dr. Robert Kelly, when asked to name the scenario that troubles him. “We get crunches some times during the winter where everyone gets sick… it starts putting strain on the system.” The Cornell/Weill campus of his network, up bedpan alley on 68th Street, is the closest trauma center to the now-closed Bellevue. It, too, has been swamped by dislocated patients, with surges of up to 150 percent of their usual numbers.

Meanwhile, Beth Israel officials are doing their best to keep up.

Joseph Santora rushed by taxicab from his home on 28th street, a literal stone’s throw away from the closed Bellevue and two blocks from NYU Lagnone Medical Center, to Beth Israel.

“I was scared,” the 68-year-old said, sitting on the steps leading out of the waiting lobby at Beth Israel Medical Center’s emergency room, where some 50 patients with injuries both serious and minor, crowded together in hopes their name would be called next. He had pneumonia and couldn’t breathe, he said. “When you can’t get oxygen, you really feel like you’re going to die.”

Because of his urgent condition, doctors zipped him passed the waiting room and into the emergency room for treatment. They stabilized him quickly. And then, like so many others, he got stuck in lower Manhattan’s healthcare gridlock. He had to wait half the day to be transferred from the emergency room to the geriatric department on the 7th floor, because, he was told, no bed was available. And like almost every patient here, he was nonetheless thankful for the care he was able to get.

“They’re doing the best they can,” he said, stubbornly smoking a cigarette despite his condition. “And you have to applaud them for that.”

An empty FDR provides a free-for-all for pedestrians. (Ian Lamb)

A zombified cell phone cluster. (Ian Lamb)

Special correspondent Ian Lamb tried to pitch in at Bellevue, but not being a doctor or a generator mechanic, he was turned away. Here is his report from the Middle to Lower East Side of Manhattan this afternoon.

There's no power anywhere on the East Side until 42nd street. Drivers were surprisingly civil but it weirds me out. Every few blocks there's a crowd of people who have found cell service; otherwise there is none. It's all very 28 Days Later.

The whole of lower/downtown/LES manhattan was really creepy this morning. The weirdest thing was driving without any traffic lights or traffic cops. Everyone was being very respectful though, everyone stopped at every intersection. No animosity between pedestrians and drivers, for once. I think everyone was just in shock, though, because by the time I was driving out of Manhattan, everyone was back to being assholes.

It seemed like there were more people out than usual, just kinda walking around. People had coffees but I'm not sure where they came from because everywhere was closed. I guess the odd bodega was open.

Both Bellevue and NYU hospitals were very creepy, pitch black inside. Still over 25 ambulances parked outside Bellevue. Lots of police activity everywhere. There was no electricity on First Avenue all the way up to 42nd.

The FDR was closed and people were walking up and down the on ramps, walking around the elevated roadway, cops looking on. It was pretty neat. Lots of water being pumped out of the basements at Stuy Town.

On Thursday, Louise Dankberg, of the Bellevue Community Advisory Board, and Carol Ann Rinzler, of the Turtle Bay Association, sent out the following email:

Lose / Lose

As of Thursday, April 15, 2010 the City of New York has called a halt to all plans to redevelop the historic Bellevue Psych Building. Often, when things fall apart, somebody wins.

In this case, no one does. The homeless men living in the building will remain in substandard housing. The community will be denied the medically-related facility that was within reach.

The NYU Langone Medical Center and the Science Park will not gain the hotel necessary to make them a truly world-class destination.

Shame on us all.

The Department of Homeless Services sought to downplay the development. According to a DHS spokesperson, the recession and related rise in demand for shelter spaced has slowed down the redevelopment process, but the agency intends to move forward at some point in the future. Further, to allay community concerns, DHS will relocate the shelter entrance to the 30th Street side of the building.

Rep. Carolyn Maloney, in a statement, said, "It is unfortunate that the Department of Homeless Services failed to come up with a concrete plan for replacing the men's shelter, but we should now work together to develop such a plan.  Right now, the Bellevue building is in terrible shape and we should not continue to house vulnerable populations there.  We need an appropriate location for a shelter in the community, and a plan to redevelop the Bellevue building in accordance with the community's needs."

It's an ignominious end to a redevelopment process that stretches back to at least spring 2008, when the city issued a request for proposals for developers interested in turning the old and storied psychiatric hospital into a hotel and conference center.

Since 1998, the site, bounded by the F.D.R. and First Avenue, and 29th and 30th streets, has served as a homeless intake center and men's homeless shelter.

The RFP elicited proposals from developer Extell, among others, and was popular in the community, but caused tremendous controversy in Crown Heights, where the homeless shelter and intake center were to be relocated.

Extell had no comment. An official from the Economic Development Agency, which oversaw the RFP process, confirmed the news, and said the RFP will remain open, should a more opportune time present itself.  

drubinstein@observer.com

"This is a cute way of trying to go around the City Council, and I'm confident it will be subject to a legal challenge," said Brooklyn Councilwoman Letitia James.

The project in question, announced in March 2008, would turn the fabled institution at First Avenue and 30th Street, which has served the psychiatric needs of legendary, and legendarily unstable, New Yorkers like Eugene O'Neil, Charles Mingus, and Allen Ginsberg, into a hotel and conference center.

At the time, according to Ms. James and Councilman Daniel Garodnick, who represents the district in which the former psychiatric hospital is located, the city promised that the project would be subject to ULURP.

In a recent letter from Christina DeRose, senior project manager at the city's Economic Development Corporation, to Community Board 6 Chair Lyle Frank, Ms. DeRose admits as much, writing:

Originally it was understood that the required public approvals for the Psych Building RFP would be ULURP and compliance with the New York City Health and Hospitals Corporation Act Section 7385(6) ("Section 7385(6)"). .... In the process of conducting due diligence for the ULURP application it was determined by the New York City Law Department that the use restrictions associated with the 2001 ULURP apply only for a disposition of the Psych Building to NYCEDC.  Since HHC will lease the Psych Building directly to the selected developer and retain the lease revenue for Bellevue Hospital, NYCEDC will not take title to the property.  Therefore the ULURP use restrictions that would apply in the case of a disposition to NYCEDC are not applicable in this situation and we can continue with the HHC disposition process.

Ms. DeRose emphasized that, once a bidder is chosen for redevelopment , the proposal will still go through an extensive public review process, including appearances before the Bellevue Community Advisory Board, Community Board 6, Manhattan Borough President Scott Stringer's office, and New York City Health and Hospitals Corporation. It would further require the approval of the HHC Board of Directors, the City Council, and Mayor Bloomberg.

That might just be enough to satisfy Messrs. Garodnick and Frank.

Read more here.

"This is a cute way of trying to go around the City Council, and I’m confident it will be subject to a legal challenge," said Brooklyn Councilwoman Letitia James.

The project in question, announced in March 2008, would turn the fabled institution at First Avenue and 30th Street, which has served the psychiatric needs of legendary, and legendarily unstable, New Yorkers like Eugene O’Neil, Charles Mingus and Allen Ginsberg, into a hotel and conference center.

At the time, according to Ms. James and Councilman Daniel Garodnick, who represents the district in which the former psychiatric hospital is located, the city promised that the project would be subject to ULURP.

A recent letter from the Economic Development Corporation to Community Board 6 Chair Lyle Frank admits as much, explaining that the city's Law Department determined, upon further review, that since the New York City Health and Hospitals Corporation will lease the property directly to the chosen developer, rather than first transferring the property to EDC, no ULURP is required.

EDC also emphasized that, once a bidder is chosen for redevelopment, the proposal will still go through an extensive public review process, including appearances before the Bellevue Community Advisory Board, Community Board 6, Manhattan Borough President Scott Stringer's office, and New York City Health and Hospitals Corporation. It would further require the approval of the HHC Board of Directors, the City Council, and Mayor Bloomberg.

That might just be enough to satisfy Messrs. Garodnick and Frank.

"If EDC commits to noticing, seeking and getting a recommendation from the community board and borough president, it may not be all that different than a ULURP process," Mr. Garodnick said.

Ms. James isn’t so sure. The reason she and other Brooklyn pols even give a hoot is that the redevelopment of the hospital has a direct impact on Crown Heights. At the moment, Bellevue houses Manhattan’s largest homeless shelter, with 850 beds, including more than 100 dedicated to homeless men with special needs, according to a recent article in the New York Press. That intake center would be relocated to the Bedford-Atlantic Armory in Crown Heights, one of the more notorious homeless shelters in the system.

"The data and evidence here are clear: You need to maintain an intake center, the front door to the homeless shelter system for homeless men in Manhattan," said Coalition for the Homeless's Patrick Magee at a recent press conference, according to NY1. "There is no reason in the world that the city should propose moving that intake center out to Brooklyn."

The city has since committed to opening another Manhattan intake center in its place, though it has yet to indicate where.

Ms. James argued that the backtracking on the ULURP process removes one of the opposition's main points of negotiating leverage with the administration. And as far as the replacement public procedures outlined in the letter are concerned, she is dubious.

The "devil is in the details," Ms. James wrote, in an email.

GEORGE: Why even bring that up? I don’t think there’s any reason to say I’ve yelled at my cat. I mean, you got me: I’m guilty. And you’ve seen what that cat can do.

HILLY: Sorry.

GEORGE: I need a refuge, I don’t know—don’t I get uncomfortable in public places?

HILLY: Yeah, I think in a similar way I do—but I react inwardly, which frustrates you, because you don’t know what I’m thinking.

GEORGE: And when you come over, we always watch television—movies—and we always get alcohol, that’s another source of conflict. So I think that adds to the irritability.

DR. SELMAN: Can you elaborate?

GEORGE: O.K. The TV part or the alcohol part?

DR. SELMAN: Alcohol.

GEORGE: I would say that 50 to 85 percent of the time we’ve spent together, there has been some alcohol involved. It’s usually in the evening when I see you. I’m not saying I don’t drink when you’re not around, but I think—haven’t I mentioned this before?

HILLY: He mentions it a lot. He gets mad at me; he calls me the guzzler.

GEORGE: I don’t know, maybe she’ll have three or four glasses of wine. But she’s not out all night, like I do sometimes, and then she gets up at the crack of dawn and goes to work, works hard all day. It’s sort of a ritual: She’ll come over, and I’ll just feel it, I’ll know that she wants me to go out and get us a bottle of Sancerre. I’m always willing to do that. I feel unproductive sometimes. The thing is, I want you to come over, and I encourage it, persuade you to come over, maybe even demand that you come over. But then, at some point, I feel I’m being unproductive and I should have read for three hours, and why am I watching this silly movie?

HILLY: I am an enabler.

DR. SELMAN: An enabler is someone that enables another person not to function.

HILLY: Well, if I show up with a bottle of wine ….

DR. SELMAN: You enable him to drink. You both drink like a bottle of wine each?

HILLY: No, no. It’s funny, too, because I do this thing with drinking that he doesn’t. I like to drink when I’m sitting around at home, not really doing anything, watching a movie, puttering around. He, on the other hand, likes to do it when he’s out socializing. And so what’s happened more over the time we’ve been together is that I drink consistently, for the most part, but George instead will go out a couple nights a week and stay out really late. If he ever brings something up to me—which is nice, I think it’s sweet, because it shows concern about me drinking—I can always easily use the defense that “Who are you to criticize when you stay out until 6 o’clock in the morning?”

DR. SELMAN: Pot calling the kettle black. Do you get drunk at those times?

GEORGE: Yeah, binge drinking. Nightclubs, bars. I am a nightlife reporter, but that can sometimes be an excuse to overdo it. We have sort of different schedules. I stay up late no matter what. Go to bed at 2, 3 in the morning, get up at 11 or so. By the time she comes over at 8 or 9 p.m., she’s sort of winding down, and that’s like late afternoon for me, you know. So I’m really awake, and she’s ready for bed by midnight. But anytime we’ve hung out during the day, it’s a different story—a better thing.

DR. SELMAN: How do you think alcohol affects your relationship? It sounds as if you raised the issue in the context of problems in the relationship. She was saying you’re irritable a lot and angry, she mentions a couple of times where you’ve had outbursts and yelled at the cat, the fuse or whatever—very often, people get irritable when they drink. Sometimes they get depressed after they drink. A hangover really is withdrawal from alcohol. You get headachy, irritable, anxious; sometimes people have panic attacks after a night of drinking.

HILLY: When the fuse thing happened, you’d been out the night before.

DR. SELMAN: Were you drinking before the “scratchy” incident?

HILLY: One glass.

GEORGE: One glass of wine.

DR. SELMAN: A little bit. It sounds like alcohol has a central role in both of your lives. You both like to drink.

GEORGE: Yep. O.K.

HILLY: And I think when we go out together, it’s less of an issue or problem. Talking about this makes me realize there’s a pretty easy solution on my part, which of course I won’t like, but I like our relationship a lot more than I like drinking—so I’d rather give that up.

GEORGE: I’d also like to be able to go out and not stay out all night.

DR. SELMAN: So I guess that you could probably both agree that if there was no alcohol involved, your relationship might be very different.

HILLY: Sometimes I get frustrated because he frequently says, “I wish I hadn’t stayed out, I wish I’d had the will power to go home at 2 o’clock.” And I always think, “Well, just discipline yourself. Give yourself a curfew, come home at 2 o’clock.”

GEORGE: She’s really good about that.

DR. SELMAN: Why do you go out so late?

GEORGE: There’s the nightlife reporting. My regular haunts. Siberia. Bellevue. Bungalow 8. Dusk. That’s sort of my social life, aside from going to work and interviewing people. I think I get kind of excited when I go out, run into people I know, and I want to extract as much as I can.

DR. SELMAN: It’s kind of an occupational hazard. You’re a nightlife reporter, then?

GEORGE: Well, I have done stories on nightlife figures, covered parties. I mean, today I was by myself, in my apartment until 6 p.m. And don’t you think I’m going out less frequently lately?

HILLY: Absolutely.

GEORGE: Tonight there’s a chance I might go out. But I’m going to do everything I can to resist it.

DR. SELMAN: Chance you’re going to go out?

GEORGE: There’s a really good party, for the Aristocrats movie, and I hope I’m not on the list. I could be persuaded to go out. By Saturday, I will have had a late night, I’m sure.

DR. SELMAN: And he goes out by himself without you?

HILLY: Well, it depends. I started the job I have now in September, and I love it more than any other job I’ve ever had. Before that, I used to go out a little bit more during the week. Now I’m almost reluctant to even start, because I feel if I’m not at home, in bed, or ready to go to sleep by 11 o’clock, then I won’t perform as well the next day. So I can’t enjoy myself as much now. Which is a shame. It would be nice if I could go out to these places and not drink—maybe that would be a different story. But to me, that’s all part of the fun. So what happens is he’ll go out and I’m fine, and I think that’s a really good thing about our relationship, being able to go our separate ways from time to time so we don’t feel that we’re smothering each other. However—and this might go back to the communication thing—sometimes I feel a little paranoid and a little jealous: I know what it’s like going out, and I just have this feeling that there are all kinds of girls throwing themselves at him. I trust him, but there was one infidelity issue that happened early in the relationship, so I think that probably adds to my paranoia sometimes. That’s another thing that I’d like to accomplish.

DR. SELMAN: Do you consider yourselves in a monogamous relationship?

HILLY: Yes.

GEORGE: (Pause) Yeah.

HILLY: That’s something we discussed early on, and there were tests involved.

GEORGE: Can I say something? I’m having some difficulties with the “end of youth.” I’m 37. On the one hand, I’m welcoming it and like the idea of being more responsible than I was four years ago, 10 years ago, but at the same time it’s hurting me. That’s coinciding with the loss of the, uh, sense of freedom. Part of it I welcome, part of it I’m sort of uncomfortable with. That make sense? Like I know it’s good for me being in this relationship, it’s centering me, but—and I know this is pretty common stuff, but I have this other part of me that—you know, like I’ve told you, “Don’t e-mail me in the morning”?

HILLY: Right.

GEORGE: Just the loss of surprise and ….

DR. SELMAN: Where do you guys think you want to go in the relationship? Where do you want to take it?

GEORGE: Can I say what just popped into my mind? “Status quo.”

HILLY: What does that mean?

GEORGE: I kind of just want to keep it where we are for now.

DR. SELMAN: And you?

HILLY: Well, I can’t imagine or I would hate for George not to be my boyfriend. I would hate it. I can’t imagine life without him. We discussed the word “marriage.” I think that I have a lot of bad habits that I need to still grow out of. I think it’s important to be in control of one’s self before getting involved in something that important financially, emotionally, living somewhere near each other. I don’t think it would be fair to drag in some of my dirty baggage. But down the road, it seems like it would be a nice thing.

GEORGE: I’m not averse to that. I think when we first met, that first night, didn’t I say I didn’t want to get married until I was 40?

HILLY: Yeah.

GEORGE: But by “status quo,” that doesn’t mean I wouldn’t like to ….

DR. SELMAN: That some day you might consider getting married.

GEORGE: Yeah. “Status quo” might have sounded bad, but I mean that here we are in therapy—I’d like to improve the relationship. I did give you a ring.

HILLY: It’s a promise ring. And he didn’t want to get it for me, but I told him that the relationship would be over if he didn’t. Because it’s just something—after so long, I just felt it was a nice kind of token of commitment. I could just know that it would help me feel better on those nights, for example, when he’s out, thinking that he isn’t going to jump in the arms of some hussy.

GEORGE: That was after three years, right? That’s like a pre-engagement kind of ring.

HILLY: Yeah. I would say at least 85 percent of our time together, if not 90, is positive. And I think that a lot of the negative things may come from myself and my inability to communicate. I don’t think George has ever heard me say that I get paranoid and jealous on nights like that when you’re out. But you probably figured it out. I mean, I think there’s some things like that we should be able to just tell each other.

Later, after that first session, over dinner on the Upper West Side, I told Hilly she could have only one glass of wine and then one at home.

HILLY: I just think I’ve had a long day and it’s really hot outside; I think it’s O.K. to have one glass to start with and one glass with dinner.

GEORGE: What about have one now and one when we go home? Because if you have one now and one during the entrée, and then we go home and watch a movie, you’re gonna want another one and that’s three. You get two tonight.

HILLY: Thirsty.

GEORGE: Do you swear, when we go back to my apartment, you won’t have another one?

HILLY: No.

GEORGE: This is going to turn into a night on the town for me, do you understand me? If we order by the glass, the odds are we won’t go out tonight. If you order a bottle, I’m going out.

HILLY: O.K., I’ll just have a lemonade.

We talked about the book she was reading on irritable-male syndrome.

HILLY: They can’t even explain it themselves—it’s not their fault, it’s a chemical imbalance. Another important point is about how men can feel “emotionally sunburned,” meaning you have a sunburn on your back but I don’t know. And I come over to give you a hug, because I want you to feel better, but it actually makes you feel worse and it hurts you.

GEORGE: Right. It’s like having P.M.S.

HILLY: Yeah!

GEORGE: All the time.

A few days later, we went to our second session.

GEORGE: [to DR. SELMAN]: I think it’s going well. I feel good. I think just the act of this … this communication.

DR. SELMAN: Maybe you could educate me on each of your individual backgrounds.

[HILLY speaks of her life, then says the longest relationship she ever had before she met GEORGE was six weeks.]

HILLY: There were a couple of those. But most recently, I guess it was the guy I was dating when I met George ….

GEORGE: From the rock band?

HILLY: No. It was a guy from—he was ….

GEORGE: I don’t want to know.

HILLY: Yeah. [laughs, then shares more family history]

GEORGE: I’m like your brother—don’t I scare you?

HILLY: Uh-huh. You do funny little pranks that aren’t malicious, but still scary sometimes.

DR. SELMAN: So being with George is like being home, a combo of your mom and your brother?

HILLY: Yeah! A little bit of my dad in there, too.

DR. SELMAN: And you, George?

[GEORGE tells his history. And then:]

GEORGE: I remember in kindergarten, the first day—all the parents were there—and the teacher told everyone to put our hands in our laps. Hands were flying everywhere, but no one put them in their laps. So the teacher said, “Now, class, don’t we know what our laps are?” And I said, “I don’t know what my lap is, but I know what my penis is!”

DR. SELMAN: That’s funny.

GEORGE: A little while after that, the girl who lived next-door to me, Heidi, sort of seduced me, and we tried to have sex. I was in first grade; she was in second grade. We did it standing up, sort of touching—didn’t quite do it properly.

DR. SELMAN: And you took your clothes off?

GEORGE: Yeah, erection, touching, sort of inside but not completely.

DR. SELMAN: This was at age 7?

GEORGE: Seven or 8, and she was one year older.

DR. SELMAN: How would you know how to do that?

GEORGE: She knew.

DR. SELMAN: I take it she was a virgin?

GEORGE: We did it about 10 times. And once with another girl from the neighborhood. And then I did it with another girl, a family friend. I think it was my idea that time. This was in Kansas. There was another girl in school, Shannon, who I was in love with, and she wasn’t reciprocating. And one day I brought four or five silver dollars and bribed her to say “I love you.” That’s weird, right? And then I threw them on the ground after she said that. That’s disturbing, right?

DR. SELMAN: What do you make of that?

GEORGE: I don’t know! Into my teens, 13, 14, maybe a little action but not much. Sort of frustrated. And then the next phase, 17 to 23, doing better, but getting really infatuated, borderline obsessed with a handful of Kansas City girls at Kansas University. That was pretty serious stuff. And then I decided, after the last one, that I absolutely would not let myself get that emotionally involved, would not let that happen again. I think through my 20’s I focused on work. Dated an older woman for about three years. It was pretty clear we weren’t going to get married. Then maybe a couple other girlfriends—nothing too serious, sort of disasters—and then Hilly.

DR. SELMAN: So you were exposed to sex at an early age?

GEORGE: Yes. Just those incidents I described. I had a subscription to Playboy in sixth grade.

DR. SELMAN: But when you were 7 years old, that’s when you made the comment to the teacher, “I don’t know what my lap is, but I know what my penis is?”

GEORGE: I think that my mother told me that we were going to call it “penis” …. We weren’t going to call it some other name, you know, not gonna call it a ….

HILLY: Hoo-ha ….

GEORGE: Or tallywhacker. So I had that in my head—I knew what my penis was. Can you tell me your reaction to any of this?

DR. SELMAN: It sounds like you were exposed to sex at an early age. Most kids don’t get a chance to have intercourse at age 9.

GEORGE: I don’t know if you’d call it intercourse, but it was definitely attempted.

DR. SELMAN: You even had what was like a threesome.

GEORGE: No kidding, no kidding.

DR. SELMAN: Where was your mother when all this was going on?

GEORGE: The last time I did it—or tried to—with the girl next-door, Heidi, we were in a closet, and we had finished writing in crayon on the wall a pact that read, “I love Heidi seven days a week and she loves me on Saturday and Sunday.” We had our pants down, and my mother opened the door. I remember Heidi pulling up her jean cutoffs. And that was that. Ten years later, my mother and I visited Heidi and her family in Texas. She was engaged. Her father picked us up and said something like, “George, so what’s it like, about to see the first girl you ever had sex with?”

DR. SELMAN: What’s your reaction?

HILLY: I don’t know. First time I heard that, I didn’t really believe it, but then, I don’t know, I thought it was almost kind of sweet.

GEORGE: It was like playing truth or dare.

HILLY: Yeah!

GEORGE: When I first went to a psychologist, I had a problem with my second-grade substitute teacher, Mrs. Jones. I started calling her Mr. Jones. Made everyone laugh. She was very patient: “George, my name is Mrs. Jones, and you should call me that.” And I said, “O.K., I will call you Mrs. Jones, but you have to call me the Fonz or Fonzie.” And she agreed—she called me Fonzie. But then it sort of deteriorated, and the next thing was I wanted my desk to be away from everyone else’s. Maybe she liked this idea, because she let me move to the back against the wall away from all the other kids.

DR. SELMAN: You were defiant.

GEORGE: Obnoxious.

DR. SELMAN: Oppositional.

GEORGE: I kept acting up. Mrs. Jones would get on the intercom and say, “Mr. Gurley is ready to go home now.” One time she was at the intercom, I said, ‘Go to hell, bitch.” I told you that, right?

HILLY: I didn’t know about the “Go to hell, bitch.”

DR. SELMAN: Was that before or after the penis and the lap?

GEORGE: This would have been two years later. I think I’ve gotten better since then, right?

[Silence.]

(to be continued)

I first heard the word "Bellevue" on the Upper East Side, in my fifth-grade classroom. Our teacher was absent. In time-honored tradition, we were trying to crush the spirit of our substitute teacher. When she turned her back, we hooted like monkeys. One kid pelted a spitball. Another emptied his little cardboard carton of milk on the floor. An eraser sailed through the air, trailing white chalk dust. Suddenly, the classroom door opened. There stood a short, balding guy in full 70's regalia: tinted aviator glasses, mustache, sideburns, polyester shirt, protruding belly, low-slung pants. To a fifth grader, this man was worthier of respect than the President of the United States. His face was haggard because we worried him continually. He cared about us, and we knew this. He was the assistant principal of P.S. 6.

He spoke from the doorway with solemn authority. "Class," he said, "I'm very disappointed. I expected more from you."

We hated dashing his expectations. We hung our heads, ashamed.

Then he administered the coup de grâce . "Watching your behavior just now," he said, "I couldn't believe I was in a place of learning. Frankly, I thought I was in Bellevue."

A chill swept through the classroom. Whatever it was, Bellevue sounded bad. Later, in the cafeteria, we students debated and conferred. None of us had ever been to Bellevue, though one boy claimed that the patients there wore straitjackets. He drew a diagram: a coffin with a lid of nails. The image of confinement lingered. Bellevue gave me nightmares.

One night, my friend Vanessa pointed Bellevue out to me. We lay side by side in our sleeping bags in the back of a station wagon. Her brother and I had been telling ghost stories on the trip back from East Hampton.

"There's Bellevue, the lunatic asylum," she whispered. "See the bars on the windows? They keep the psychos in chains. When we drive by, you'll hear them scream."

In the light from the street lamp, a dark fortress loomed over Central Park West, radiating a sinister air. I could just make out the barred windows and detect faint screams. This wasn't Bellevue at all, as my mom clarified later that night. It was the Dakota. Not the stately co-op of today, but the Dakota in its youth, before its façade was cleaned up-the way Roman Polanski shot it for Rosemary's Baby . Crouched on the corner like a giant bat, black with layers of soot, it was easy to envision schizophrenic Satan worshippers lurking around in there.

I finally went to Bellevue a few weeks ago, 30 years after I dreamed about it. The trip to Bellevue began with a panicked phone call from a dear old friend whom I'll call Serge. Every New Yorker has a Serge, someone brilliant, crazy and beloved. Boyish though pushing 40, Serge is a charmer. A talented chef, he's a restless globetrotter, a former banker, model and Parisian gallery owner. He's also a manic-depressive who had run out of medication, resorting to an infusion of Absolut vodka.

"I can't stop drinking," he said. "I'm going through two quarts a day."

After a round of phone calls, a trusted doctor recommended Bellevue as the only hospital in town that would admit Serge for free. It provides treatment to the unstable, cross-addicted, alcoholic, felonious, uninsured and unemployed. Naturally, our glamorous bad boy fell into every category.

After we'd made arrangements to meet with a psychiatrist there, only one pressing question remained. What to wear? For our visit to Bellevue, my husband and I opted for sweaters and jeans. Serge, however, elected to dress up instead of down. When we picked him up at the studio apartment where he was poisoning himself, he sported Prada, head to toe. The only exception was his eyeglasses. "Chanel," he noted, dryly. ("Manic. Shopping spree," he explained.) He was certainly the most elegant of impoverished mental patients. He was also plastered. After he'd poured himself "one last martini" to celebrate his date with detox, we discovered that Serge no longer possessed the ability to walk. Bellevue was only four blocks away, but we arrived in style, hopping a cab. To my surprise, there was no dark tower. We drove up to a perfectly ordinary, modestly attractive modern hospital. What is remarkable about Bellevue is only that it turns no one away. Ask a cab driver, a laid-off dot-commer or an illegal alien from Haiti, and they'll agree: If you're sick or injured and short of cash, Bellevue is the place to be.

We soon found ourselves in the belly of the beast-the admissions office of the psychiatric unit. Here, Bellevue began to live up to its scary old reputation. The 400-pound man sitting beside us, accompanied by an armed police escort, was handcuffed to a sturdy metal bar. (We didn't ask.)

After we'd filled out forms and met some friendly hospital personnel, a cute young doctor appeared and led Serge away. When they returned, several hours later, Prada was out. Serge was wearing standard-issue blue hospital pajamas, shuffling down the hallway in paper slippers. Without his designer threads, he seemed fragile and disheartened. He'd been hospitalized once before, in New England, after attempting suicide as a teenager. The memory pained him. "Before I go up to the mental ward," he said, now sober, "I need a cigarette." He looked imploringly from me to my husband to the doctor.

"You can't smoke inside Bellevue, Serge," the doctor said, pointing at the "No Smoking" sign.

"My God," Serge muttered. "Please give me a break. I mean, you took away my cell phone. You took away my clothes!"

I'm not sure what strings the doctor pulled, but the rules were overlooked somehow. Although Serge was a registered patient, confined to the grounds, he was allowed to slip past the security guards. Accompanied by the doctor, we stepped outside Bellevue's utterly normal, not-Gothic, not-creepy main entrance into the winter night. We stomped our feet in the cold-three pairs of sneakers and one pair of nerdy-chic Prada booties, which had temporarily been returned to Serge, together with his cell phone and his pack of Marlboros. He lit up. Three reformed smokers looked on as smoke encircled his shaved head.

"So, honey, are you going to put me in a straitjacket now?" Serge asked gamely.

The young psychiatrist grinned. The mood lifted. He patted our pal, fondly, on the shoulder. For a moment, we weren't outside Bellevue, but at a party, laughing and flirting. Crazy or not, Serge's presence can do that. He passed around his cigarette and, one by one, we took a drag.

When you're one of the hottest universities in the country-attracting 30,000 applicants a year for a mere 4,000 spaces-growth is inevitable. When that growth must take place downtown in a crowded city like New York, conflict is also virtually inevitable.

New York University-which has had its share of such conflicts-is, however, managing a major dorm expansion in the East Village with virtually no clashes with growth-weary neighbors. Perhaps the involvement of a private developer helped ease the way. Or perhaps N.Y.U.'s and the developer's willingness to negotiate and compromise did the job.

At the Oct. 4 meeting of Board 3, representatives of the developer told board members that they were ready to move ahead with construction of a new 12-story building at the corner of East Second Street and Bowery that will include 153 new N.Y.U. dorm rooms. And absent any pending board votes or major complaints, the developers were beginning excavations on Friday, Oct. 12.

N.Y.U. will act as the dormitory's landlord under the terms of a 10-year lease that it signed with Coral Realty, a Little Italy construction company that has renovated or built four other dorms for N.Y.U. since 1995. The present incarnation will house some 400 students in 90 double-occupancy studios and 63 triple-occupancy units.

Inevitably, many locals weren't thrilled at the prospect of a 128-foot tower going up on a block of Andrew Jackson–era brownstones.

"Everybody would rather have a tropical greenhouse," said resident Neal Johnston. "It would be wonderful if it wasn't there, but [Coral and N.Y.U.] are working hard to try to address individual concerns."

Specifically, residents contended that the main entrance, originally slated for Second Street, would have disrupted a quiet residential block. In response, Coral announced at the Oct. 4 meeting that it would move the entrance to Bowery, which is more heavily trafficked.

Locals also said that the influx of porch-sitters and partygoers would translate into litter-strewn streets. Coral and N.Y.U. agreed to institute a special trash-removal program.

The building developers have also promised to use brownstone-colored bricks on the dormitory's façade, and to plant some trees along Second Street, all to maintain the residential ambiance.

And to satisfy concerns about access to a rear entrance for the Amato Opera building next door, the developers have promised to build a cut-through, allowing Amato's performers to enter the theater through the dormitory.

The dormitory is an "as-of-right" construction, meaning that Coral didn't need any zoning variances to erect it. Coral was also allowed by law to build at roughly twice the square footage of a general residential building because of special zoning rules for community buildings like dorms.

The rooms will each have a full kitchen and bathroom, and there will be laundry facilities in the basement. In compliance with zoning regulations for community facilities, the building will also include a study-recreation room that will be open to neighborhood residents, said Coral's project manager, Tom Whalen.

The units seem to be so plush, in fact, that many residents have expressed their fears to The Observer that Coral would attempt to let them out at increased prices to the general public when N.Y.U.'s lease expires. Mr. Whalen rejected the claim as spurious, noting that the very provision that allows him to build a larger-than-normal building also restricts that building from ever reverting back to general-populace dwellings.

"If the University rents all [the units], we'll have one tenant, one check. If we have to rent it out privately, we'll have to deal with 153 tenants," Mr. Whalen told The Observer . "That is the absolute last thing that would be good for us."

-Blair Golson

N.Y.U. Develops Better Biotech Plan

Board 6 members gave each other pats on the back at their Oct. 10 meeting. They have made their voices heard, and the result will be significant changes in New York University's East River Science Park, a proposed million-square-foot biotech facility on land bounded by 28th and 30th streets, First Avenue and the F.D.R. Drive.

"This is a perfect scenario for community involvement in a development plan," chairman Mark Taylor told The Observer. "It is exactly what should happen in city development, where developers tap the expertise of community leaders, amending their plans accordingly."

In 1794, the city bought a large parcel of East River farmland which Bellevue, the nation's oldest public hospital, has been occupying since 1811. Part of the surplus land now in question is home to garages, Bellevue's obsolete laundry facility and the old psychiatric building, which has been housing a homeless shelter.

In 1999, the city's Economic Development Corporation and the Health and Hospitals Corporation issued a request for "Expressions of Interest," preferably including commercial biotechnology labs, for what they deemed surplus public property. Of the seven proposals received, they concluded that the N.Y.U. School of Medicine's was the best.

Their plan involves razing the laundry building, renovating the psychiatric building and constructing three new facilities. They estimate the new facility will attract 1,500 biotech jobs. Funding for the project will be private and public.

As part of the city's Uniform Land Use Review Procedure (ULURP), the city asked for Board 6's support for its planned disposition of city land. At a presentation in July, the board rejected the bulk of the ULURP application.

Throughout August, architects of Ehrenkrantz, Eckstut & Kuhn worked with Board 6 to create a master plan best suiting the needs of both parties. The Oct. 10 presentation showed the culmination of those efforts.

The board's main concerns had been public space and waterfront access. Members worried that new buildings would obstruct north-south campus walkways and prohibit pedestrian river access. The new plans have largely assuaged these concerns. Peter Cavaluzzi, a design principal for the architectural firm, told The Observer that Board 6 is responsible for increasing the development's campus feel and allowing more pedestrian areas, making it "less about buildings and more about public space."

Yet even with those design issues resolved, Board 6 members still have concerns about the larger issues involved in turning over such a vast public area to private development. And the board's concerns often are weighed heavily by the city's Planning Commission and the City Council, both of which must approve the plan before it can go forward.

Board members said they fear that, hoping to resolve the matter before Mayor Rudolph Giuliani's term ends, N.Y.U.'s plans have been rushed and not fully thought out.

In addition, Board 6 members said they worry that Mr. Giuliani, who has never championed public hospitals, is not looking out for Bellevue's long-term interests. What land will be used to expand Bellevue in the future? Will access to Bellevue's emergency facilities be hindered? Will Bellevue receive any credit or profit for discoveries made on property it has occupied for two centuries?

LaRay Brown, a vice president of the Health and Hospitals Corporation, told The Observer in July that Bellevue will benefit financially by not having to maintain the property. It will also gain housing, child care, parking and, through an affiliation in which the teaching hospital provides staff to the public one, coveted new doctors drawn to the N.Y.U. biotech labs.

Still, Board 6 thinks that slowing the pace would allow more time to think the full impact through.

"I begin to think I'm holding up the progress of mankind by asking simple questions," Mr. Taylor told The Observer . "It's a great project, but I don't see the rush."

Mr. Taylor said the board will continue to discuss these issues. Meanwhile, out of appreciation for the compromises N.Y.U. has made to its plan, the board is expected in November to overturn its July rejection and support the East River Science Park, Mr. Taylor said.

- Anna Jane Grossman

Oct. 17: Board 8, New York Blood Center, 310 East 67th Street, between First and Second avenues, auditorium, 7 p.m., 758-4340.

Oct. 18: Board 9, Community Board Office, 565 West 125th Street, between Broadway and Old Broadway, 6:30 p.m., 864-6200; Board 2, St. Vincent's Hospital, 170 West 12th Street, between Sixth and Seventh avenues, 10th floor, 6:30 p.m., 979-2272.

Oct. 23: Board 1, Pace University, Spruce Street between Gold and Nassau streets, 6 p.m., 442-5050; Board 12, Columbia University Alumni Auditorium, 650 West 168th Street, between Fort Washington Avenue and Broadway, 7 p.m., 568-8500.

One recent evening, Mr. Munson was in a cab on his way to Bellevue, a bar on 40th Street and Ninth Avenue.

"I realized at a very early time moving to New York City that my life was going to be shit out of luck unless I did something that made more fucking money–or as much money–as a drug dealer," he said. "There was only one thing that you could do, other than being a drug dealer, which I have no aptitude for anyway. Selling stock. So during good times, I make as much as a top drug dealer or mob guy–legally! Ethically."

Mr. Munson's big dark eyes were dancing. "And I make the clients money. I mean, I make people money!" he hollered. "That's what I do! I'll never leave!

"New York is a reincarnation of ancient Rome at its peak!" he said. "Not at its peak–at its decline! When Nero was playing the skin flute, watching Rome burn …. That's what we're going through right now, and God bless it! I want to be a citizen of Rome, and to do that, you have to be a broker.

"The New York experience is everything I ever dreamed of," he said. "Just being able to be like a rock star, have the financial power to bully–not people–but bully the city around and make the city meld into what I wanted the city to be."

We sat down at a table at Bellevue. He said he was one of his firm's youngest brokers. How good was he?

"Some people would say I'm in the top 1 percent of brokers, but I would say, safely, I'm in the top 5 to 10 percent," he said.

"I really feel that being a broker is like winning the fucking lottery, even now," Mr. Munson continued. "People who win the lottery spend all their money and end up depressed. Maybe the market's shit and I don't make any money, but in a year from now, I'm in the lottery again."

He said he got up at 6 a.m. that day. "First thought is, 'Don't wake up, don't make the mistake of going to work, don't do it!'" he said. "'Because Lee, the market stinks!'

"In good times, you love to wake up," he said. "Because you're going to wake up and make thousands of dollars today! Wow! It's like, 'What am I going to buy today? What new car am I going to get?' So you get up; you have to go to a sales meeting at 7:15 every morning. I'm the late one–I always come in like 7:27, 7:30. I'm the one who's always on the verge of being fired."

The meeting is over by 8 a.m. "First thing I do, by 8 a.m., I'm a badass. I'm like a hot producer, I'm the hot money man," he said. "First fucking thing I do, 8 o'clock, 8:01? I start dialing numbers! Any fucking numbers! Let's do it, let's get it on, let's get the ball rolling . I call people I don't know, introducing yourself, warming up the voice!

"I tell the client what to do. I can show you how to manage cash–cash. Maybe you need to get out of that crappy tech stock that you don't know anything about into another good tech stock that's at a crappy price …. And being a stockbroker, every fucking day , you can do business. It's not like being a venture capitalist, three and 10 years and all that."

He got up, put some money in the jukebox, then sat back down. In 2000, he said, he was living the high life.

"Fast cars, one woman," he said. "Cristal. Blue Ribbon sushi. Nobu on a weekly basis. The Palm comes to mind. Whatever cost a lot of money, that's what I had. I was always a punk rocker at heart, so what I love to do is take all my friends out and just buy 'em drinks at the cool places. It was like, 'On me, baby!' Share the wealth a little bit.

"You ever been out and you're at some nice restaurant, and there's this table with these guys and they're all loud?" he said. "Who are these fucking guys? They're just dicks. Those are brokers! And they're just guys like you and me who got into a weird career, had a knack for it, and just have so much money, it's like a rock star. The only difference is, a rock star, you recognize him–he's a rock star, he has a license to be bad. Brokers aren't recognizable, but they believe they have a license to be bad, too. Because they make so much money. Ninety-nine percent of the people who try to get in the business fail . Most people cannot do it. So when you actually do make it, you realize that you're special . People start treating you differently, you got a little money. Then you try to get involved in high society, it's a disaster–or you get involved in slumming it. And the quintessential broker slums. Why? They're trying to feel something real , because a little while before they were just kids trying to work and earn a dollar.

"And you go to bars and get in fights. Out with the boys, you go out, drunk as fuck, and we'll just start fighting amongst ourselves. We just start hitting each other and getting kicked out of bars."

He described "a perfect night" with his broker friends: "You start off at Barmacy to see if there's any cute dumb college girls there. Then you pick them up, take them to Lakeside, and then you get a chick who's out of college, who's a broad now, and if you strike out there, you go all the way to Motor City and get some filthy whore in leather pants, who just like broke up with her boyfriend Biff over at the garage."

What would the brokers be talking about?

"'Isn't it great to be a fucking broker?'" he said. "'We make so much more than everybody else. Look at all the people in the bar: They're all scumbags! We make more in a day than they make all year!' That's what brokers like to talk about; it's the ultimate in mental masturbation."

And since the recent slump?

"We're the pariahs of society. Nobody loves us. Nobody gives us business. We're still drinking $80 bottles of champagne instead of $500 bottles … and we're crying all the way."

The female bartender turned off the jukebox and led patrons in a rendition of "Happy Birthday."

"What the fuck is that?" Mr. Munson said. "Did I pay for half a fucking Scorpions song? Yes or no? No ! If I paid 15 cents a song, I'd understand. Put that music back on, whore!"

'Podunkville'

Mr. Munson grew up in a big house in Modesto, Calif. His father was a mortgage banker, his mother a music teacher. Young Lee was raised to be a banker.

"They were so concerned about me being a little man, they neglected to remember that I was also a little boy, " he said. "It made me feel there was no place to be a child. 'You're so much better than all the other kids.' And I wanted to hang out with the other kids, but they weren't good enough, so I spent a lot of time alone."

When he was 5, he developed Legg-Perthes disease, a hip disorder, and a doctor thought ballet dancing might be a good idea. He took lessons, and had to wear a hip brace for a year.

He was a smart kid, but "always pissed." He was expelled in fourth grade for being disruptive.

"I just thought it was all stupid," he said. "I wanted to be a businessman. I wanted to make money like my Dad did. School is stupid. "

He got A's, skipped a grade, but got in trouble for fighting. "I liked to pick on people who were weaker than me, kids who obviously would grow up to be sissies," he said. "But my Dad didn't give a shit because he was fucked up. And my mom thought that if anyone says you're fucked up, they're fucked up. This was not good. You need to make kids feel like they're like other kids. It had the effect of making me feel I was so different ."

In 11th grade he was a friendless but good-looking "dork" who got involved in theater. "The one thing I had: for such a dork, I got more pussy than captain of the football team," he said. "I had these gay hairdressers, and I used to tell them, 'George–or Bruce, or whatever–I want girls to like me.' And they're like, 'I don't know what to do about that, but I know how to make a boy like you.'"

He said he seduced lots of girls; their mothers liked him. "They thought, 'How can my daughter be doing anything with him? And if my daughter is, Lee is such a nice boy,' I'm like, 'Yeah, your girl's pussy is very nice. And I want to fuck you too, Ma.'"

But he wasn't happy.

"There was always something inside that was building up that was ready to start to lash out," he said. "I just realized that I was meant for so much greater. I was in Podunkville."

He graduated high school at 16 and went to France, to "do French chicks." He found work in a tree nursery and fell in love with a hash-smoking older girl who kicked him out when she found out how old he was.

"I went to France thinking I wanted to find a French woman and just live the rest of my life speaking French, making French love," he said. His mother visited and brought him home. Georgetown University rejected him. He went to the small, 400-student St. John's College in Santa Fe, N.M., where he met his wife, Alison Bamert, whom he found to be "fucking hot and, like, cool."

He graduated and found a job as an intern at an art gallery in San Francisco. "I fucking rocked the world," he said. "I'm like a superstar! I got into the art business; I was a made man. They blessed me."

But he didn't think much of his contemporaries in San Francisco. "They were bums, thinking about being in college for another 10 years. I was like, 'Dude, I want to be a millionaire in another 10 years.' They were a bunch of sprout-eating whores."

One night Mr. Munson was sitting at a bar in Las Vegas, playing craps. "I realized that L.A. is the worst art market for fucking pussies and sissies and people who had no taste," he said. "I said, 'I'm going to go to the big time, baby. Who's the big pimp?' And somebody at the bar said, ' You are!' And I'm like, ' Yeah, I'm moving to New York , baby!'"

A week later he was in Manhattan.

'I Want to Bleed on You'

Bellevue was filling up. Mr. Munson was talking about Microsoft.

"If you're pissed off at Microsoft for having a monopoly and controlling the world, and Bill Gates is the Antichrist, stop whining," he said. "Why don't you buy the stock, make a million dollars, then go build a bomb and blow 'em up? But you know, people aren't man enough to do that. When I make money, I put it in Wall Street's face, man. Put it in their fucking face.

"I consider myself a capitalist," he said. "Purebred. And you know what, I think the world is sick . And communism is so concerned about the world and helping your fellow brother. Fuck you, my fellow brother sucks . Why do I want to help him ? He's a scumbag."

He was standing now, his hands outstretched.

"If I ripped my skin out, you know what would flow out?" he asked. "Bloody cash, baby. Money! Rip it out, it's gold!"

Mr. Munson held his arms up higher, crucifixion-style.

"I want to be like Jesus," he said. "You know why? 'Cause I'm rich with blood and I want to bleed on you, because you'll be wealthy if I bleed on you. Or maybe if you're a bitch, I'll fucking squirt you with a little bit of silver."

The next day I called Mr. Munson's wife, Alison Bamert. They were married three and a half years ago by an Elvis impersonator in Las Vegas. They live with a cat in a large one-bedroom on Ninth Avenue and 30th Street. Sometimes Mr. Munson comes home drunk, and his wife yells at him and then gets him up for work at 6 a.m.

"Lee really rocks and he's totally interesting, but you have to keep in mind that he shouldn't always be taken, like, completely literally, " she said. "You can look at what's coming out of his mouth as just like an interesting, sociological, quirky thing. He's very interested in playing mind games with people and seeing what reaction he gets. And if you don't realize that, that can really turn people off.

"You know," she said, "he calls me on the phone and he'll be like, 'I've just lost my mind.' And I'm like, 'Well, that's a bit of a dramatic thing to say–you know, words really do have a lot of impact and you need to be ….' Sometimes he's not fully conscious of the weight of his blunt language."

On a Friday after work, Mr. Munson met me at the Plaza Hotel. The host at the Oak Bar was sorry to say that Mr. Munson could not be photographed on the premises. We walked to a bar nearby called Whiskey Park. After a few photos, a striking blond hostess told us we had to stop.

"This place pretty much is the last place on Earth I would want to be photographed in," Mr. Munson said, and then snarled, "Rock 'n' roll, baby ."

"Since you're 12 years old, you're a little too young to be in here anyway," she said.

Mr. Munson spat on one of the windows.

Later, listening to my interviews with Mr. Munson, I realized he had picked up my tape recorder and spoken into it when I was in the bathroom.

What he said was: "You're in the bathroom and I've taken control of your tape recorder. I don't really think you're a sissy . You're a little girly . I got a little pissed when you were hitting on my wife, but it's understandable. She's hot and you're not. But all I can say is, I'm enjoying this night. Pretty much. And if you fuck me over, I'll kill you. I don't have any problem with that. But I have to say that I hope that we become friends after this."

The next day, the market rebounded slightly.